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CUA GUIDELINE
ORIGINAL RESEARCH

UPDATE – Canadian Urological Association

guideline: Male lower urinary tract symptoms/

benign prostatic hyperplasia

Dean Elterman , Mélanie Aubé-Peterkin , Howard Evans , Hazem Elmansy , Malek Meskawi , Kevin C. Zorn ,
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Naeem Bhojani 5
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1 Division of Urology, University of Toronto, Toronto, ON, Canada; Division of Urology, McGill University, Montreal, QC, Canada; Division of Urology, University of Alberta, Edmonton, AB, Canada; Division
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of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Division of Urology, Université de Montréal, Montreal, QC, Canada
Cite as: Elterman D, Aubé-Peterkin M, Evans H, et al. UPDATE – Canadian Urological Association with causes other than BPO may require more extensive
guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J diagnostic workup and different treatment considerations.
2022;16(8):245-56. http://dx.doi.org/10.5489/cuaj.7906 We acknowledge that not all patients identify as male. These
guidelines should also be applicable to non-binary people,
transwomen, and any patients who may have anatomical
Published online April 11, 2022
features of a cis-male genitourinary tract, such as a prostate.
It is our intent to make these guidelines inclusive to all per-
sons experiencing LUTS or an enlarged prostate.
Introduction In this document, we will address both diagnostic and
treatment issues. Diagnostic guidelines are described in the
The current document summarizes the state-of-the-art know- following terms as: mandatory, recommended, optional, or
ledge as it relates to management of male lower urinary tract not recommended. The recommendations for diagnostic
symptoms (MLUTS) secondary to benign prostatic hyperplasia guidelines and principles of treatment were developed on the
(BPH) by updating the 2018 Canadian Urological Association basis of clinical principle (widely agreed upon by Canadian
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(CUA) BPH guideline. The process continues to highlight the urologists) and/or expert opinion (consensus of committee
essential diagnostic and therapeutic information in a Canadian and reviewers). The grade of recommendation will not be
context. The information included in this document includes offered for diagnostic recommendations. Guidelines for
that reviewed for the 2010 guideline and further information treatment are described using the GRADE approach for
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obtained from an updated MEDLINE search of the English- summarizing the evidence and making recommendations.
language literature (search terms included BPH, alpha-block-
ers, 5-alpha reductase inhibitor, anti-cholinergic, beta3 agon- 1. Diagnostic guidelines
ist, phosphodiesterase type 5 inhibitor [PDE5I], transurethral
resection of the prostate [TURP], monopolar, bipolar, open The committee recommended minor revisions in regard to
simple prostatectomy, enucleation, GreenLight, photoselect- diagnostic considerations as outlined in the 2018 CUA BPH
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ive vaporization of the prostate [PVP], Aquablation, Rezum, guideline.
UroLift, temporarily implanted nitinol device [iTiND]), as well
as review of the most recent American Urological Association 1.1. Mandatory
(AUA) and European Association of Urology (EAU) guide-
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lines. References include those of historical importance, but Mandatory evaluations include:
management recommendations are based on literature pub- - History
lished between 2000 and 2021. When information and data - Physical examination, including DRE
is available from multiple sources, the most relevant (usually - Urinalysis
most recent) article is cited based on committee opinion. In the initial evaluation of a man presenting with LUTS,
These guidelines are directed toward the typical male the evaluation of symptom severity and bother is essen-
patient over 50 years of age presenting with LUTS and benign tial. Medical history should include relevant prior and cur-
prostatic enlargement (BPE) and/or benign prostatic obstruc- rent illnesses, as well as prior surgery and trauma. Current
tion (BPO). It is recognized that men with LUTS associated medication, including over-the-counter drugs and phyto-

CUAJ • August 2022 • Volume 16, Issue 8 245
© 2022 Canadian Urological Association